Coping in the Aftermath When a Client Dies by Suicide

Note: This article contains information regarding death by suicide that may be triggering to some individuals.  

It was almost as if he never had a chance.

He was raised in a generational cycle of abuse that had started in childhood.

He went through a lot of different therapies and medication for physical and emotional pain, made honest attempts at finding faith and friendship, and conducted a valiant search for mastery, meaning, and joy.

On the day of our last regular Thursday session, this client denied any suicidal ideation or plan. There was a calmness about him as he showed me his new jacket and talked about his life.

The next morning, he stepped in front of a train and ended his life.

Working through the aftermath of a client’s suicide

As his therapist, when I heard the news, I was in shock for hours. I cried for the pain that he must have been facing that day.

All my what ifs? came to me in a barrage as I replayed our last session over and over in my mind, looking for any clues that I might have missed. 

His family reached out and assured me that they knew that he had been “just miserable” for years.

My own support system assured me that I couldn’t have stopped him from ending his life.

With the information I had, I slowly tried to put the puzzle of his life and death together in the best way I knew how. Ultimately, what I came to accept was that he simply didn’t cry out for help in that last session—most likely because he didn’t want to be stopped.

The death of a client by suicide is significant, and has a powerful impact of the professional lives of everyone involved.

For me, the experience was an immediate emotional jolt that, coupled with the actual grief over the loss, is something that I personally will never forget. The shock and the emotional aftermath I experienced were what led me on a search for support and comfort through more research on client suicide.

Understanding suicide prevention

Despite the training we receive as clinicians in identifying risk factors and developing the clinical protocol to prevent suicide, suicide still does happen.

In certain cases, we aren’t able to keep our clients safe from self-harm. A disheartening study from a few years ago found that clients often have contact with their psychiatrist near the time of their suicide.

One study found that 58% of clients who died by suicide had contact with their psychiatrist within one week of their death—17% on that same day. 

Unlike in the medical field where it’s more common knowledge that there will be a percentage of patients who die despite all attempts to treat them, in the world of mental health, a suicide is sometimes perceived as a lack of—or failure of—appropriate clinical care.

For the general public or an inexperienced clinician, it would be much more beneficial to drive home the point that suicide is more likely an occupational hazard of working in the mental health industry. 

When it happens, we have to remember that while we most likely did everything right, a person’s decision to end their own life is their own decision—and this point is exactly what I had to come to terms with myself. 

The impact on clinicians 

When clients die by suicide, clinicians often report feeling alone on both a personal and professional level and left with feelings of grief, anxiety, and guilt. Personally, there was a sense of immediate shame, as if I was ineffective and that I somehow contributed to the outcome.

This couldn’t have been further from the truth of the matter—yet it seems to be a natural first reaction.

The difficult subject of client suicide is slowly becoming less taboo, but there’s still a lot of work to be done to break the stigma.

One reason that stigma remains is that suicide is still cloaked in a lot of shame, mystery, and a lack of understanding.

I certainly faced that taboo in my experience, and more recently, a colleague of mine was told by his legal counsel that he shouldn’t discuss the situation with the family. He was told they could take legal action against him, and that he shouldn’t reach out or share his own experience and risk breaking confidentiality. 

While these are definitely real concerns clinicians face in the aftermath of a client suicide, that advice still left me feeling that if we can’t share our experiences with others, it’s still perceived as something shameful or wrong. There has to be a balance we can strike between protecting our client’s privacy and sharing our experience with other humans.  

How to cope with the aftermath of a client suicide

There’s no easy way to come to terms with the death of a client.

However, as a foundational step, clinicians need to take their own healing just as personally as they would for a client.

The ACA code of ethics recommends a few simple steps: 

Engage in self-care and wellness activities

This may seem to go without saying, but these activities are often the first to go by the wayside in times of grief. Be sure to increase focus on healthy nutrition, physical activity, spending time in nature and with loved ones. If it’s helpful for you, express your emotions through art, writing or another form of creativity, or engage in a spiritual practice that gives you comfort.  Also, be aware of needing extra rest while experiencing grief. 

Reach out for personal counseling, peer support, supervision, or consultation with a mentor

By participating in seeking our own support, we acknowledge our limits as well as our humanity as counselors. We can demonstrate for our clients and our community what it means to embody the journey of healing and hope that the counseling relationship has to offer. 

Support the family, if you can 

Though this can be a tricky area to navigate, many therapists and ethics experts have argued that there are ways to support the family of your client after their death, without breaching your client confidentiality.

The American Counseling Association (ACA) has published guidance advising therapists to make sure, if you’re asked by the family to attend funeral services or offer support, that you feel fully capable and willing to do so. Other clinicians have argued that the support you offer to a grieving family is a combination of support, references and resources, and compassion—and that this approach actually fulfills your ethical obligation to do no harm. 

Whether or not you have contact with the family afterwards will depend on a lot of different factors, so there’s no one-size-fits-all approach here. If you’re unsure the best course of action for your specific situation, contact your professional ethics board or an attorney

While it has been over ten years since the suicide, I still think of my client quite often and quietly send him blessings for peace. I have fully accepted the fact that there was truly nothing more that I could have done.

Suicide is a personal decision, and so it would never serve me to take it personally, as my intent was most certainly never to do any harm. I know that I did absolutely everything I could to help. 

Over time, the intense and painful circumstances have helped me to mature in my clinical skills and to be more aware of and curious about the things that aren’t necessarily spoken outwardly by my clients.

Ultimately, I gained great respect for the idea that there is a space between my clients and myself that is sacred—a space that I will, in most cases, never have access to.

While I can’t control their individual actions and decisions, what I can control are my own narratives about the things they choose to do with their lives. I can be just as forgiving of myself just as I am with them. After all, we are only human.

SimplePractice Learning is offering 1.5 hours CE  A Therapist’s Loss: Grieving our Clients (Live) on September 29, 2023 from 9 AM to 10:30 AM PT. (NOTE: If you register for this event but are unable to attend, a recorded version that provides 1.5 hours CE credit will be available at no additional cost.)

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